Stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma: imaging evaluation post treatment

Surgical resection, when feasible, is the standard of care for hepatocellular carcinoma. However, many tumours are not resectable at the time of diagnosis. Recently, stereotactic body radiation therapy (SBRT) has emerged as a non-invasive local therapy for both non-resectable primary hepatic malignancies as well as hepatic metastases. Knowledge of the expected hepatic parenchymal appearance post treatment, as well as potential pitfalls and complications, is essential for accurate evaluation of treatment response. This pictorial review provides a fundamental description of the SBRT technique, outlines the expected cross-sectional imaging appearances of tumour response, and highlights potential pitfalls in interpretation. The expected liver parenchymal changes post-SBRT are also reviewed, along with some common radiation-induced complications.